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Daniel M Musher - One of the best experts on this subject based on the ideXlab platform.
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clostridium difficile infection in patients with unexplained Leukocytosis
The American Journal of Medicine, 2003Co-Authors: Anna Wanahita, Elizabeth A Goldsmith, Bernard Marino, Daniel M MusherAbstract:Abstract Purpose To determine whether unrecognized Clostridium difficile infection is responsible for a substantial proportion of cases of unexplained Leukocytosis in a tertiary care hospital setting. Methods We prospectively identified 60 patients who had unexplained Leukocytosis (white blood cell count ≥15,000/mm 3 ). Fecal specimens were tested for C. difficile toxin using an enzyme immunosorbent assay. We compared the clinical features of patients who had positive or negative assay results, as well as of 26 hospitalized control patients who did not have unexplained Leukocytosis. Results Thirty-five (58%) of the patients with unexplained Leukocytosis had C. difficile toxin in at least one fecal specimen as compared with 3 (12%) of the controls ( P C. difficile toxin, Leukocytosis also tended to resolve during empiric therapy with metronidazole; some of these patients may have had C. difficile infection. Conclusion The majority of patients in our hospital who had unexplained Leukocytosis had C. difficile infection. Unexplained Leukocytosis in hospitalized patients should prompt a search for symptoms and signs consistent with C. difficile infection and a study to detect C. difficile . Empiric therapy with metronidazole may be effective in the appropriate epidemiologic setting.
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conditions associated with Leukocytosis in a tertiary care hospital with particular attention to the role of infection caused by clostridium difficile
Clinical Infectious Diseases, 2002Co-Authors: Anna Wanahita, Elizabeth A Goldsmith, Daniel M MusherAbstract:Few modern studies have enumerated the conditions associated with Leukocytosis. Our clinical experience has implicated Clostridium difficile infection in a substantial proportion of patients with Leukocytosis. In a prospective, observational study of 400 inpatients with WBC counts of >/=15,000 cells/mm(3), we documented >/=1 infection in 207 patients (53%). Of these 207 patients, 97 (47%) had pneumonia, 60 (29%) had urinary tract infection, 34 (16%) had soft-tissue infection, and 34 (16%) had C. difficile infection. C. difficile infection was present in 25% of patients with WBC counts of >30,000 cells/mm(3) who did not have hematological malignancy. Other causes of Leukocytosis in the 400 patients included physiological stress, in 152 patients (38%); medications or drugs, in 42 (11%); hematological disease, in 22 (6%); and necrosis or inflammation, in 22 (6%). C. difficile infection is a prominent cause of Leukocytosis and this diagnosis should be considered for patients with WBC counts of >/=15,000 cells/mm(3), even in the absence of diarrheal symptoms.
Eric Deutsch - One of the best experts on this subject based on the ideXlab platform.
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neutrophilia as prognostic biomarker in locally advanced stage iii lung cancer
PLOS ONE, 2018Co-Authors: Antoine Schernberg, Alexandre Escande, Laura Mezquita, A Boros, A Botticella, C Caramella, Benjamin Besse, David Planchard, Cecile Le Pechoux, Eric DeutschAbstract:Objective To study the prognostic value of baseline Leukocytosis or neutrophiliain two retrospective cohorts of stage III Non-Small Cell Lung Cancer (NSCLC) patients. Materials and methods Clinical records of consecutive previously untreated NSCLC patients in our Institution between June 2001 and September 2016 for stage III NSCLC were collected. The prognostic value of pretreatment leucocyte disorders was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as a leukocyte count or a neutrophil count exceeding 10 and 7 G/L, respectively. Results We identified 238 patients, displaying baseline Leukocytosis or neutrophilia in 39% and 40% respectively. Most were diagnosed with adenocarcinoma (48%), and stage IIIB NSCLC (58%). 3-year actuarial overall survival (OS) and progression-free survival (PFS) were 35% and 27% respectively. Local relapses were reported in 100 patients (42%), and distant metastases in 132 patients (55%). In multivariate analysis, Leukocytosis, neutrophilia, and induction chemotherapy regimen based on carboplatin/paclitaxel were associated with worse OS and PFS (p<0.05). Neutrophilia independently decreased Locoregional Control (LRC) (HR = 2.5, p<0.001) and Distant Metastasis Control (DMC) (HR = 2.1, p<0.001). Neutrophilia was significantly associated with worse brain metastasis control (p = 0.004), mostly in adenocarcinoma patients (p<0.001). Conclusion In stage III NSCLC patients, treated with concurrent cisplatin-based chemoradiation, baseline Leukocytosis and neutrophilia were associated with worse OS, PFS, LRC, and DMC. In addition with previously available markers, this independent cost-effective biomarker could help to stratify stage III NSCLC population with more accuracy.
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external validation of Leukocytosis and neutrophilia as a prognostic marker in anal carcinoma treated with definitive chemoradiation
Radiotherapy and Oncology, 2017Co-Authors: Antoine Schernberg, Alexandre Escande, Eric Deutsch, Eleonor Rivin Del Campo, Cyrus Chargari, F Huguet, L Moureauzabotto, Michel Schlienger, Emmanuel TouboulAbstract:Abstract Purpose To validate the prognostic value of leukocyte disorders in anal squamous cell carcinoma (SCC) patients receiving definitive concurrent chemoradiation. Materials and methods Bi-institutional clinical records from consecutive patients treated between 2001 and 2015 with definitive chemoradiation for anal SCC were retrospectively reviewed. Prognostic value of pretreatment leukocyte disorders was examined, with focus on patterns of relapse and survival. Leukocytosis and neutrophilia were defined as leukocyte or neutrophil count exceeding 10G/L and 7G/L, respectively. Results We identified 133 patients, treated in two institutions. Eight% and 7% displayed baseline Leukocytosis and neutrophilia, respectively. Estimated 3-year overall survival (OS) and progression-free survival (PFS) were 88% and 77%, respectively. In univariate analysis, both Leukocytosis and neutrophilia were associated with worse OS, PFS ( p p p Conclusion This study validates Leukocytosis and neutrophilia as independent prognostic factors in anal SCC patients treated with definitive chemoradiation. Although prospective confirmation is warranted, it is suggested that the leukocyte and neutrophil count parameters are clinically relevant biomarkers to be considered for further clinical investigations.
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Leukocytosis and neutrophilia predict outcome in locally advanced esophageal cancer treated with definitive chemoradiation
Oncotarget, 2017Co-Authors: Antoine Schernberg, Alexandre Escande, Eric Deutsch, Eleonor Rivin Del Campo, Michel Ducreux, Diane Goere, Cyrus Chargari, L MoureauzabottoAbstract:// Antoine Schernberg 1 , Laurence Moureau-Zabotto 2 , Eleonor Rivin Del Campo 1 , Alexandre Escande 1 , Michel Ducreux 3, 4 , France Nguyen 1 , Diane Goere 5 , Cyrus Chargari 1, 6, 7, 8 , Eric Deutsch 1, 3, 6 1 Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France 2 Radiation Oncology Department, Institut Paoli-Calmettes, Marseille, France 3 Universite Paris Sud, Universite Paris Saclay, Faculte de medecine du Kremlin-Bicetre, Le Kremlin-Bicetre, France 4 Department of Medical Oncology, Gustave Roussy, Universite Paris-Saclay, Villejuif, France 5 Department of Surgery, Gustave Roussy, Universite Paris-Saclay, Villejuif, France 6 INSERM1030, Gustave Roussy Cancer Campus, Villejuif France 7 French Military Health Services Academy, Ecole du Val-de-Grâce, Paris, France 8 Institut de Recherche Biomedicale des Armees, Bretigny-sur-Orge, France Correspondence to: Eric Deutsch, email: eric.deutsch@gustaveroussy.fr Keywords: esophageal cancer, concurrent chemoradiation, prognostic factor, biomarker, Leukocytosis Received: November 09, 2016 Accepted: December 26, 2016 Published: January 10, 2017 ABSTRACT Purpose: To investigate the prognostic value of leukocyte and neutrophil count as biomarkers in patients with locally advanced esophageal squamous cell carcinoma (SCC) undergoing exclusive chemoradiation. Results: A total of 126 patients were identified. Respectively, 33% and 35% displayed baseline Leukocytosis and neutrophilia. Estimated 3-year OS and PFS from chemoradiation completion were 31% and 25%, respectively. In univariate analysis, both Leukocytosis and neutrophilia were associated with worse OS, PFS, and LRC ( p < 0.01). In multivariate analysis, Leukocytosis remained an independent risk factor associated with poorer OS, PFS and LRC ( p < 0.05), independently from tumor stage and length, with higher prognostic value for OS compared with patients’ performance status (PS). Materials and Methods: Bi-institutional clinical records from consecutive non-operable patients treated between 2003 and 2015 with definitive chemoradiation for locally advanced esophageal carcinoma were reviewed. Leukocytosis and neutrophilia were defined as a leukocyte or neutrophil count over 10 G/L and 7 G/L, respectively. These parameters were studied for their potential correlation with overall survival (OS), progression free survival (PFS), locoregional control (LRC) and distant metastases control (DMC). Conclusions: Leukocytosis and neutrophilia were independent prognostic factors of poor OS, PFS, and LRC in this bi-institutional series of locally advanced esophageal SCC treated with definitive chemoradiation. Although prospective confirmation is warranted, it is suggested that the leukocyte and neutrophil count parameters might be clinically relevant biomarkers to be considered for further clinical investigations.
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Leukocytosis and neutrophilia predicts outcome in anal cancer
Radiotherapy and Oncology, 2017Co-Authors: Antoine Schernberg, Alexandre Escande, Eric Deutsch, Eleonor Rivin Del Campo, Michel Ducreux, Diane Goere, Cyrus ChargariAbstract:Abstract Objective Leukocytosis and neutrophilia could be the tip of the iceberg in the inflammatory tumor microenvironment. We aimed to validate their prognostic significance in a cohort of patients treated with definitive chemoradiation for anal squamous cell carcinoma (SCC). Materials & methods Clinical records from all consecutive patients treated in a single institution between 2006 and 2016 with curative-intent radiotherapy were retrospectively analyzed. Leukocytosis and neutrophilia, defined as leukocyte or neutrophil count over 10,000 and 7500/mm 3 , respectively, were studied in terms of overall survival (OS), progression (PFS), locoregional (LFS) and distant (DFS)-free survival. Results We identified 103 non-metastatic HIV-negative patients, with concurrent chemotherapy use in 78%. Twelve and 8% displayed baseline Leukocytosis and neutrophilia, respectively. Estimated 3-year OS and PFS were 88% and 67%, respectively. In univariate analysis, both Leukocytosis and neutrophilia were strongly associated with inferior OS, PFS, LFS and DFS ( p p Conclusion Leukocytosis and neutrophilia are strong prognostic factors for OS, PFS, LFS and DFS in anal cancer treated with chemoradiation. These biomarkers could help identify patients with higher risk of tumor relapse that require treatment intensification.
Michael J Mauro - One of the best experts on this subject based on the ideXlab platform.
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a novel paradigm between Leukocytosis g csf secretion neutrophil to lymphocyte ratio myeloid derived suppressor cells and prognosis in non small cell lung cancer
Frontiers in Oncology, 2019Co-Authors: Montreh Tavakkoli, Cy Wilkins, Jodi V Mones, Michael J MauroAbstract:Leukocytosis is a common feature of malignancies. While controversial, there appears to be an association between the degree of tumor-related Leukocytosis and prognosis. In this paper, we provide evidence supporting an untapped clinical paradigm linking G-CSF secretion to the induction of Leukocytosis and expansion of myeloid-derived suppressor cells, providing an explanation for the association between Leukocytosis, elevated neutrophil-to-lymphocyte ratios and prognosis in non-small cell lung cancer. Clinically validating this mechanism may identify MDSCs and G-CSF as dynamic markers of early disease progression and therapeutic response, and shed light onto novel therapeutic avenues for the treatment of patients with non-small cell lung cancer.
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the significance of Leukocytosis in malignancies a novel paradigm between Leukocytosis g csf myeloid derived suppressor cells and prognosis
Blood, 2018Co-Authors: Montreh Tavakkoli, Cy Wilkins, Jodi V Mones, Michael J MauroAbstract:Abstract In clinical practice, Leukocytosis is often overlooked after infectious and hematologic disease are ruled out, particularly in patients with solid tumors. This is unfortunate, as the mechanisms that mediate paraneoplastic Leukocytosis may play a significant role in the underlying pathophysiology of cancer progression and prognosis. The relatively new discovery of neutrophilic and monocytic myeloid-derived suppressor cells (MDSCs) and their role in mediating tumor metastasis has particularly shed light into this process [Annu Rev Med, 66:97-110 (2015)]. Here, we present the case of a 58-year old gentleman with non-small cell lung cancer complicated by brain metastasis, status post resection who presented with sepsis and acute kidney injury (AKI) requiring ICU care for worsening AKI, hypoxic respiratory failure and Leukocytosis. His peak WBC count, absolute neutrophilia and monocytosis were: 178.1, 172.7 and 4.2k/µL, respectively. His peripheral blood smear revealed mature neutrophils with left-shift and no blast forms. The underlying etiology of his Leukocytosis was initially attributed to steroids administration and infection (Figure 1). His Leukocytosis progressed, however, despite improvement in his sepsis and tapering of his steroids. Thus, we suspected either an evolving hematologic neoplasm or exogenous secretion of G-CSF by his tumor. Nonetheless, given his worsening clinical status, we initiated empiric hydroxyurea and leukapheresis. His FISH and PCR for BCR-ABL were negative in addition to the absence of leukemia-associated mutations and gene fusions and a normal phenotype by flow cytometry. However, we detected the highest documented level of G-CSF secreted by any tumor in the literature at 41,108.6pg/mL (normal On evaluation of this patient's clinical history, his malignancy and white count were stable until day 388 of his diagnosis when he developed new onset Leukocytosis and neutrophilia associated with disease progression and metastasis. Furthermore, he died within 23 days of developing peak Leukocytosis, neutrophilia and monocytosis and the discovery of his profoundly elevated G-CSF level. The association between the onset of his Leukocytosis with the discovery of his disease progression and metastasis suggest that G-CSF secretion and Leukocytosis may have been linked to his poor prognosis. We performed an extensive literature review and found that neutrophilic and monocytic MDSCs may provide a potential explanation for this phenomenon. We believe that Leukocytosis in the setting of solid neoplasms may be driven by increased G-CSF secretion by tumors or tumor microenvironments. Additionally, G-CSF secretion fosters the expansion of neutrophilic and monocytic MDSCs, which play a significant role in tumor progression and metastasis and may contribute to poor prognosis [PNAS 106(16): 6742-7 (2009), PNAS 107(50): 21248-55 (2010)]. Consequently, we believe that the significance of Leukocytosis in patients with solid tumors should not be overlooked and that there may exist a novel, untapped paradigm between paraneoplastic G-CSF secretion, Leukocytosis, neutrophilic and monocytic MDSCs and prognosis. Disclosures Mauro: Novartis: Consultancy, Research Funding; Pfizer: Consultancy; Takeda: Consultancy; Bristol-Myers Squibb: Consultancy.
Ayalew Tefferi - One of the best experts on this subject based on the ideXlab platform.
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the prognostic relevance of serum lactate dehydrogenase and mild bone marrow reticulin fibrosis in essential thrombocythemia
American Journal of Hematology, 2017Co-Authors: Mythri Mudireddy, Naseema Gangat, Daniela Barraco, Curtis A Hanson, Animesh Pardanani, Ayalew TefferiAbstract:The 2016 World Health Organization (WHO) diagnostic criteria for myeloproliferative neoplasms (MPN) underscore the prognostically-relevant distinction between essential thrombocythemia (ET) and prefibrotic primary myelofibrosis (pre-PMF). In addition, Leukocytosis has been identified as an important prognostic marker in otherwise WHO-defined ET. However, controversy remains regarding the objectivity of morphologic criteria in distinguishing ET from pre-PMF and the precise prognostic cutoff values for Leukocytosis. Serum lactate dehydrogenase (LDH) level might be a biologically more accurate measure of leukocyte turnover and a more sensitive marker of pre-PMF, in otherwise WHO-defined ET. In the current study of 183 consecutive patients with WHO-defined ET, the presence of grade 1 bone marrow (BM) fibrosis did not affect presenting clinical or laboratory features; in contrast, increased serum LDH at diagnosis was associated with Leukocytosis (p = .002), thrombocytosis (p < .001), palpable splenomegaly (p = .03) and higher international prognostic score (IPSET) (p = .002); serum LDH did not correlate with BM fibrosis, JAK2/CALR/MPL or TET2/ASXL1 mutations. In univariate analysis, risk factors for survival included age ≥60 years (p = .002; HR 10.2, 95% CI 2.3-44.6), male sex (p = .02; HR 3.2, 95% CI 1.2-8.2), leukocyte count ≥15 × 109/L (p = .007; HR 4.7, 95% CI 1.5-14.6), and increased serum LDH (p = .002; HR 3.7, 95% CI 1.5-9.1), but not BM fibrosis (p = .17). In multivariable analysis, age, sex and serum LDH remained significant; serum LDH also remained significant, in the context of IPSET (p = .003) and in patients with Leukocytosis (p = .003). We conclude that serum LDH level carries an independent prognostic value for survival in ET and might represent a biologically more accurate surrogate for Leukocytosis.
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Leukocytosis and presence of calr mutation is associated with non hepatosplenic extramedullary hematopoiesis in primary myelofibrosis
Blood Cancer Journal, 2016Co-Authors: Daniela Barraco, Naseema Gangat, Animesh Pardanani, Terra L Lasho, Christy Finke, Yoseph Elala, Ayalew TefferiAbstract:Leukocytosis and presence of CALR mutation is associated with non-hepatosplenic extramedullary hematopoiesis in primary myelofibrosis
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Blast transformation and fibrotic progression in polycythemia vera and essential thrombocythemia: a literature review of incidence and risk factors
Blood Cancer Journal, 2015Co-Authors: S Cerquozzi, Ayalew TefferiAbstract:Polycythemia vera (PV) and essential thrombocythemia (ET) constitute two of the three BCR-ABL1 -negative myeloproliferative neoplasms and are characterized by relatively long median survivals (approximately 14 and 20 years, respectively). Potentially fatal disease complications in PV and ET include disease transformation into myelofibrosis (MF) or acute myeloid leukemia (AML). The range of reported frequencies for post-PV MF were 4.9–6% at 10 years and 6–14% at 15 years and for post-ET MF were 0.8–4.9% at 10 years and 4–11% at 15 years. The corresponding figures for post-PV AML were 2.3–14.4% at 10 years and 5.5–18.7% at 15 years and for post-ET AML were 0.7–3% at 10 years and 2.1–5.3% at 15 years. Risk factors cited for post-PV MF include advanced age, Leukocytosis, reticulin fibrosis, splenomegaly and JAK2V617F allele burden and for post-ET MF include advanced age, Leukocytosis, anemia, reticulin fibrosis, absence of JAK2V617F , use of anagrelide and presence of ASXL1 mutation. Risk factors for post-PV AML include advanced age, Leukocytosis, reticulin fibrosis, splenomegaly, abnormal karyotype, TP53 or RUNX1 mutations as well as use of pipobroman, radiophosphorus (P^32) and busulfan and for post-ET AML include advanced age, Leukocytosis, anemia, extreme thrombocytosis, thrombosis, reticulin fibrosis, TP53 or RUNX1 mutations. It is important to note that some of the aforementioned incidence figures and risk factor determinations are probably inaccurate and at times conflicting because of the retrospective nature of studies and the inadvertent labeling, in some studies, of patients with prefibrotic primary MF or ‘masked’ PV, as ET. Ultimately, transformation of MPN leads to poor outcomes and management remains challenging. Further understanding of the molecular events leading to disease transformation is being investigated.
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Leukocytosis at diagnosis and the risk of subsequent thrombosis in patients with low risk essential thrombocythemia and polycythemia vera
Cancer, 2009Co-Authors: Naseema Gangat, Curtis A Hanson, Alexandra P Wolanskyj, Susan M Schwager, Ayalew TefferiAbstract:BACKGROUND: Advanced age and a history of thrombosis were well-established risk factors for thrombosis in essential thrombocythemia (ET) and polycythemia vera (PV); cytoreductive therapy was indicated in their presence. Recent studies have suggested Leukocytosis as an additional risk factor; however, such an association would be treatment-relevant in the context of low-risk disease. METHODS: In this retrospective study, a Cox proportional hazards model was used to determine the impact of various clinical and laboratory variables, including Leukocytosis, on thrombosis-free survival (TFS). Arterial-specific or venous-specific TFS curves for different leukocyte count-defined risk groups were constructed by the Kaplan-Meier method and compared using the log-rank test. RESULTS: A total of 407 low-risk patients (254 with ET and 153 with PV) were considered. After a respective median follow-up of 104 months and 130 months, respectively, 47 (19%) patients with ET and 41 (27%) with PV experienced a total of 55 (41 arterial and 14 venous) and 46 (22 arterial and 24 venous) thrombotic events, respectively. Leukocytosis at the time of diagnosis, defined by a cutoff level of either 15 or 9.4 × 109/L, did not appear to be predictive of either arterial or venous thrombosis during follow-up; similar results were obtained when analysis was restricted to patients with platelet counts of <1000 × 109/L. Instead, advanced age was found to be significantly associated with arterial thrombosis in patients with PV and higher hemoglobin level with venous thrombosis in patients with ET. CONCLUSIONS: In the current retrospective study, Leukocytosis at diagnosis did not appear to influence the risk of thrombosis in either ET or PV. However, a prospective study is required before Leukocytosis is taken into account during treatment decisions in these disorders. Cancer 2009. © 2009 American Cancer Society.
Montreh Tavakkoli - One of the best experts on this subject based on the ideXlab platform.
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a novel paradigm between Leukocytosis g csf secretion neutrophil to lymphocyte ratio myeloid derived suppressor cells and prognosis in non small cell lung cancer
Frontiers in Oncology, 2019Co-Authors: Montreh Tavakkoli, Cy Wilkins, Jodi V Mones, Michael J MauroAbstract:Leukocytosis is a common feature of malignancies. While controversial, there appears to be an association between the degree of tumor-related Leukocytosis and prognosis. In this paper, we provide evidence supporting an untapped clinical paradigm linking G-CSF secretion to the induction of Leukocytosis and expansion of myeloid-derived suppressor cells, providing an explanation for the association between Leukocytosis, elevated neutrophil-to-lymphocyte ratios and prognosis in non-small cell lung cancer. Clinically validating this mechanism may identify MDSCs and G-CSF as dynamic markers of early disease progression and therapeutic response, and shed light onto novel therapeutic avenues for the treatment of patients with non-small cell lung cancer.
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the significance of Leukocytosis in malignancies a novel paradigm between Leukocytosis g csf myeloid derived suppressor cells and prognosis
Blood, 2018Co-Authors: Montreh Tavakkoli, Cy Wilkins, Jodi V Mones, Michael J MauroAbstract:Abstract In clinical practice, Leukocytosis is often overlooked after infectious and hematologic disease are ruled out, particularly in patients with solid tumors. This is unfortunate, as the mechanisms that mediate paraneoplastic Leukocytosis may play a significant role in the underlying pathophysiology of cancer progression and prognosis. The relatively new discovery of neutrophilic and monocytic myeloid-derived suppressor cells (MDSCs) and their role in mediating tumor metastasis has particularly shed light into this process [Annu Rev Med, 66:97-110 (2015)]. Here, we present the case of a 58-year old gentleman with non-small cell lung cancer complicated by brain metastasis, status post resection who presented with sepsis and acute kidney injury (AKI) requiring ICU care for worsening AKI, hypoxic respiratory failure and Leukocytosis. His peak WBC count, absolute neutrophilia and monocytosis were: 178.1, 172.7 and 4.2k/µL, respectively. His peripheral blood smear revealed mature neutrophils with left-shift and no blast forms. The underlying etiology of his Leukocytosis was initially attributed to steroids administration and infection (Figure 1). His Leukocytosis progressed, however, despite improvement in his sepsis and tapering of his steroids. Thus, we suspected either an evolving hematologic neoplasm or exogenous secretion of G-CSF by his tumor. Nonetheless, given his worsening clinical status, we initiated empiric hydroxyurea and leukapheresis. His FISH and PCR for BCR-ABL were negative in addition to the absence of leukemia-associated mutations and gene fusions and a normal phenotype by flow cytometry. However, we detected the highest documented level of G-CSF secreted by any tumor in the literature at 41,108.6pg/mL (normal On evaluation of this patient's clinical history, his malignancy and white count were stable until day 388 of his diagnosis when he developed new onset Leukocytosis and neutrophilia associated with disease progression and metastasis. Furthermore, he died within 23 days of developing peak Leukocytosis, neutrophilia and monocytosis and the discovery of his profoundly elevated G-CSF level. The association between the onset of his Leukocytosis with the discovery of his disease progression and metastasis suggest that G-CSF secretion and Leukocytosis may have been linked to his poor prognosis. We performed an extensive literature review and found that neutrophilic and monocytic MDSCs may provide a potential explanation for this phenomenon. We believe that Leukocytosis in the setting of solid neoplasms may be driven by increased G-CSF secretion by tumors or tumor microenvironments. Additionally, G-CSF secretion fosters the expansion of neutrophilic and monocytic MDSCs, which play a significant role in tumor progression and metastasis and may contribute to poor prognosis [PNAS 106(16): 6742-7 (2009), PNAS 107(50): 21248-55 (2010)]. Consequently, we believe that the significance of Leukocytosis in patients with solid tumors should not be overlooked and that there may exist a novel, untapped paradigm between paraneoplastic G-CSF secretion, Leukocytosis, neutrophilic and monocytic MDSCs and prognosis. Disclosures Mauro: Novartis: Consultancy, Research Funding; Pfizer: Consultancy; Takeda: Consultancy; Bristol-Myers Squibb: Consultancy.